Cedar Court Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question inadequate. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

At the last inspection, the service was in breach of regulation in relation to working within the principles of the Mental Capacity Act 2005 (MCA). At this inspection, we found the service was still in breach of regulation in relation to working within the principles of the MCA.

At the last inspection, the service was in breach of regulation in relation to meeting the nutritional and hydration needs of people. At this inspection, we found enough improvements had been made and the service was no longer in breach.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider involved people and their relatives in creating and reviewing care and support needs by communicating with them through this process. However, the care plans we reviewed had sections for information about people’s religion and culture, likes and dislikes, social interests and hobbies to be noted. The care plans did not contain sufficient detail around each of these needs for people. This left people not able to verbalise their needs themselves, at risk of being supported by staff who did not have information to treat them as individuals or to offer them support they might require in relation to their protected characteristics.

Some people and their relatives told us they were involved in the creating and reviews of care plans and risk assessments. We received comments like, “I was involved in care planning at the beginning and then it’s updated. If I am concerned about anything they give me updates.”, and “Yes, we were involved in devising a care plan. They took into account [relatives] risk factors.”

Staff had access to care plans and risk assessments in handheld devices. Relatives had access to view people’s records and daily notes through a secure portal.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. The information recorded in some care plans was ambiguous, confusing and provided limited person-centred information. This meant staff did not always have sufficient information to support people appropriately in line with their care needs.For example, we saw ABC records which help to identify behaviour patterns for people requiring additional behavioural support including how a person’s anxiety and distress presents. The information was poorly completed and did not provide sufficient information of how staff should intervene to support people. We saw records referring to people as ‘aggressive’, or ‘agitated.’ With no further information documented.

We observed interactions with people at lunchtime. Some staff did not engage people while they were supporting them to eat, while we saw some good interactions between people and other members of staff.

A relative told us, “The food is nice; there are menu’s up. It is sometimes cold as the kitchen is downstairs, and the food comes up in a lift.” However, people did compliment the food and said that they thought the food was nice, and they had enough to eat.

One person’s care plan provided specific information relating to how staff should support them at mealtimes. The care plan referred to staff offering a dessert to the person before the main meal to encourage their appetite. Staff were observed to not follow the instruction detailed within the care plan. Staff did not routinely explain to people what the meal provided was, despite many people living with dementia. This was particularly evident at breakfast and lunchtime meals. People and their relatives told us people had access to snacks throughout the day.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their inspection of needs when people moved between different services. At the time of the inspection people were not being moved between different services, however, there were care plans and risk inspections in place. People and their relatives told us they had access to the care plans.

The service had recently introduced Person Centred Software system, (PCS) and were nearing the end of transferring care plans onto this system. All care staff had access to people’s care plans on mobile devices and were able to review care plans without restriction. Daily care notes and medicines administered were updated on the PCS system. We received feedback from health and social care professionals who told us they worked well with staff and management, and staff were always willing to take advice and work on improving the service for people.

The staff we spoke to, told us they felt they were able to communicate with management and were happy to approach with any concerns they had. The management team had daily flash meetings where all issues, concerns and ideas were discussed. There were longer staff meetings held once a month. The management team attended multidisciplinary meetings every week.

The provider supported people to manage their health and wellbeing. One person told us they needed support from their social worker to access dental support care. However, overall, people told us they felt supported as much as possible to manage their own health needs. Relatives told us the service worked well with healthcare professionals. The service worked well with the GP practice. They would liaise with district nurses, chiropodists and paramedics as required. The service would also keep relatives up to date about all issues, changes or requirements in relation to people’s health and wellbeing. Relatives said they were routinely asked about people having flu, covid or any relevant vaccinations. We spoke to health care professionals who told us the service worked well with them to ensure people had access to healthcare.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Care plans for people who required additional behaviour support did not have sufficient information about how staff should support them documented. For example, we reviewed a care plan for a person who required additional support in relation to behaviour, stress and anxiety. However, things that might trigger a person’s anxiety or distress, and actions to take to manage this were not recorded. Some records referred to people being ‘aggressive’ or ‘agitated’ with no further clarification. This left people at risk of being supported by staff who did not fully know how to support them safely. We discussed this with the management team at the end of the first day of the inspection.

Staff did not always seek consent from people relating to their care and treatment. This referred to not all staff asking people if they wished to wear a clothes protector prior to eating and drinking, providing sufficient drink choices throughout the day or giving people the choice to watch television or listen to music. A member of staff was observed attempting to remove a person’s untouched lunchtime plate of food without advising them or gaining their consent to do so. The impact of this led to the person using the service becoming physically distressed. We fed this back to the management team at the end of the first day of inspection.